Skip to main content
Log in

Femoral and tibial bone bruise volume is not correlated with ALL injury or rotational instability in patients with ACL-deficient knee

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 28 May 2020

This article has been updated

Abstract

Purpose

Some researchers have suggested that bone bruises are evidence of rotational instability. The hypothesis was that the extent of lateral bone edema is correlated with the presence of an anterolateral ligament (ALL) injury. The main objective was to determine whether there was a correlation between the presence of an ALL injury the extent of bone bruises.

Methods

A prospective diagnostic study enrolled all the patients who suffered an acute anterior cruciate ligament (ACL) who were operated on within 8 weeks. The extent of bone bruising according to the ICRS classification was measured on preoperative MRIs by two independent blinded raters twice with an interval of 4 weeks. Dynamic ultrasonography (US) to look for ALL injury and the pivot shift test were performed before the ACL surgery. The correlation between ALL injury and bone bruises, and the correlation between an ALL injury and a high-grade pivot shift test were determined.

Results

Sixty-one patients were included; 52% of patients had an ALL injury on US. The extent of lateral bone bruise was not related to the presence of an ALL injury, nor related to the presence of a high-grade pivot shift. A grade 2 or 3 pivot shift was significantly correlated with an ALL injury (p < 0.0001). Inter- and intra-rater reliability for the bone bruise rating was excellent.

Conclusion

The extent of lateral bone bruise is not correlated with ALL injury or a high-grade pivot shift; thus, it is not correlated with rotational instability of the knee.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

Abbreviations

ACL:

Anterior cruciate ligament

ALL:

Anterior lateral ligament

BMI:

Body mass index

CI:

Confidence interval

ICC:

Intra-class correlation

ICRS:

International Cartilage Research Society

MRI:

Magnetic resonance imaging

US:

Ultrasonography

PD-FS:

Proton-density fat saturation

References

  1. Bastos R, Andrade R, Vasta S, Pereira R, Papalia R, van der Merwe W, Rodeo S, Espregueira-Mendes J (2019) Tibiofemoral bone bruise volume is not associated with meniscal injury and knee laxity in patients with anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 27:3318–3326

    PubMed  Google Scholar 

  2. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85(Suppl 2):58–69

    Google Scholar 

  3. Cavaignac E, Castoldi M, Marot V, Courtot L, Gracia G, Reina N (2019) Minimally invasive ultrasound-guided anterolateral ligament reconstruction with autologous 2-strand gracilis graft. Arthrosc Tech 8:e685–e689

    PubMed  PubMed Central  Google Scholar 

  4. Cavaignac E, Faruch M, Wytrykowski K, Constant O, Murgier J, Berard E, Chiron P (2017) Ultrasonographic evaluation of anterolateral ligament injuries: correlation with magnetic resonance imaging and pivot-shift testing. Arthroscopy 33:1384–1390

    PubMed  Google Scholar 

  5. Cavaignac E, Laumond G, Reina N, Wytrykowski K, Murgier J, Faruch M, Chiron P (2018) How to test the anterolateral ligament with ultrasound. Arthrosc Tech 7:e29–e31

    PubMed  Google Scholar 

  6. Cavaignac E, Saithna A, Monaco E, Helito CP, Daggett M, Reina N, Sonnery-Cottet B (2018) Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction? Letter to the editor. Am J Sports Med 46:NP13–NP14

    PubMed  Google Scholar 

  7. Cavaignac E, Wytrykowski K, Reina N, Pailhé R, Murgier J, Faruch M (2016) Ultrasonographic identification of the anterolateral ligament of the knee. Arthroscopy 32:120–126

    PubMed  Google Scholar 

  8. Christel P, Djian P (2002) Anterio-lateral extra-articular tenodesis of the knee using a short strip of fascia lata. Rev Chir Orthop Reparatrice Appar Mot 88:508–513

    CAS  PubMed  Google Scholar 

  9. Claes S, Bartholomeeusen S, Bellemans J (2014) High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 80:45–49

    PubMed  Google Scholar 

  10. Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30:1475–1482

    PubMed  Google Scholar 

  11. Devitt BM, O’Sullivan R, Feller JA, Lash N, Porter TJ, Webster KE, Whitehead TS (2017) MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 25:1345–1351

    PubMed  Google Scholar 

  12. Dombrowski ME, Costello JM, Ohashi B, Murawski CD, Rothrauff BB, Arilla FV, Friel NA, Fu FH, Debski RE, Musahl V (2016) Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee. Knee Surg Sports Traumatol Arthrosc 24:2854–2860

    PubMed  Google Scholar 

  13. Dunn WR, Spindler KP, Amendola A, Andrish JT, Kaeding CC, Marx RG, McCarty EC, Parker RD, Harrell FE, An AQ, Wright RW, Brophy RH, Matava MJ, Flanigan DC, Huston LJ, Jones MH, Wolcott ML, Vidal AF, Wolf BR, Investigation MOONACL (2010) Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. Am J Sports Med 38:1778–1787

    PubMed  PubMed Central  Google Scholar 

  14. Faruch Bilfeld M, Cavaignac E, Wytrykowski K, Constans O, Lapègue F, Chiavassa Gandois H, Larbi A, Sans N (2018) Anterolateral ligament injuries in knees with an anterior cruciate ligament tear: contribution of ultrasonography and MRI. Eur Radiol 28:58–65

    PubMed  Google Scholar 

  15. Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50

    Google Scholar 

  16. Helfer L, Vieira TD, Praz C, Fayard JM, Thaunat M, Saithna A, Sonnery-Cottet B (2020) Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift. Knee Surg Sports Traumatol Arthrosc 28:381–388

    PubMed  Google Scholar 

  17. Helito CP, Helito PVP, Leão RV, Louza ICF, Bordalo-Rodrigues M, Cerri GG (2018) Magnetic resonance imaging assessment of the normal knee anterolateral ligament in children and adolescents. Skelet Radiol 47:1263–1268

    Google Scholar 

  18. Herbst E, Hoser C, Tecklenburg K, Filipovic M, Dallapozza C, Herbort M, Fink C (2015) The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc 23:2250–2258

    PubMed  Google Scholar 

  19. Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM (2015) Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy 31:2022–2034

    PubMed  Google Scholar 

  20. Illingworth KD, Hensler D, Casagranda B, Borrero C, van Eck CF, Fu FH (2014) Relationship between bone bruise volume and the presence of meniscal tears in acute anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 22:2181–2186

    PubMed  Google Scholar 

  21. Inderhaug E, Stephen JM, Williams A, Amis AA (2017) Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med 45:347–354

    PubMed  Google Scholar 

  22. Jakob RP, Stäubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Jt Surg Br 69:294–299

    CAS  Google Scholar 

  23. Kanakamedala AC, Burnham JM, Pfeiffer TR, Herbst E, Kowalczuk M, Popchak A, Irrgang J, Fu FH, Musahl V (2017) Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc 26(5):1399–1405

    PubMed  Google Scholar 

  24. Kızılgöz V, Sivrioğlu AK, Ulusoy GR, Aydın H, Karayol SS, Menderes U (2017) Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies. Clin Imaging 50:20–30

    PubMed  Google Scholar 

  25. Kornblatt I, Warren RF, Wickiewicz TL (1988) Long-term followup of anterior cruciate ligament reconstruction using the quadriceps tendon substitution for chronic anterior cruciate ligament insufficiency. Am J Sports Med 16:444–448

    CAS  PubMed  Google Scholar 

  26. Li X, Ma BC, Bolbos RI, Stahl R, Lozano J, Zuo J, Lin K, Link TM, Safran M, Majumdar S (2008) Quantitative assessment of bone marrow edema-like lesion and overlying cartilage in knees with osteoarthritis and anterior cruciate ligament tear using MR imaging and spectroscopic imaging at 3 Tesla. J Magn Reson Imaging 28:453–461

    PubMed  PubMed Central  Google Scholar 

  27. Machin D (ed) (2008) Sample size tables for clinical studies. Wiley, Hoboken, pp 184–185

    Google Scholar 

  28. Mathew M, Dhollander A, Getgood A (2018) Anterolateral ligament reconstruction or extra-articular tenodesis: why and when? Clin Sports Med 37:75–86

    PubMed  Google Scholar 

  29. Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15:1168–1174

    CAS  PubMed  Google Scholar 

  30. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329

    PubMed  Google Scholar 

  31. Slette EL, Mikula JD, Schon JM, Marchetti DC, Kheir MM, Turnbull TL, LaPrade RF (2016) Biomechanical results of lateral extra-articular tenodesis procedures of the knee: a systematic review. Arthroscopy 32:2592–2611

    PubMed  Google Scholar 

  32. Song G-Y, Zhang H, Wang Q-Q, Zhang J, Li Y, Feng H (2016) Bone Contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Arthroscopy 32:2331–2341

    PubMed  Google Scholar 

  33. Sonnery-Cottet B, Daggett M, Fayard J-M, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S (2017) Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament—deficient knee. J Orthop Traumatol 18:91–106

    PubMed  PubMed Central  Google Scholar 

  34. Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BHB, Murphy CG, Claes S (2015) Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med 43:1598–1605

    PubMed  Google Scholar 

  35. Szkopek K, Warming T, Neergaard K, Jørgensen HL, Christensen HE, Krogsgaard M (2012) Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture. Scand J Med Sci Sports 22:635–642

    CAS  PubMed  Google Scholar 

  36. Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X (2011) Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1ρ) magnetic resonance imaging: 1-year cohort study. Arthroscopy 27:65–76

    PubMed  Google Scholar 

  37. Van Dyck P, Clockaerts S, Vanhoenacker FM, Lambrecht V, Wouters K, De Smet E, Gielen JL, Parizel PM (2016) Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries. Eur Radiol 26:3383–3391

    PubMed  Google Scholar 

  38. Viskontas DG, Giuffre BM, Duggal N, Graham D, Parker D, Coolican M (2008) Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med 36:927–933

    PubMed  Google Scholar 

  39. Wittstein J, Vinson E, Garrett W (2014) Comparison between sexes of bone contusions and meniscal tear patterns in noncontact anterior cruciate ligament injuries. Am J Sports Med 42:1401–1407

    PubMed  Google Scholar 

  40. Wytrykowski K, Swider P, Reina N, Murgier J, Laffosse JM, Chiron P, Cavaignac E (2016) Cadaveric study comparing the biomechanical properties of grafts used for knee anterolateral ligament reconstruction. Arthroscopy 32:2288–2294

    PubMed  Google Scholar 

  41. Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli GM, Bignozzi S, Visani A, Marcacci M (2012) Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 20:153–159

    CAS  PubMed  Google Scholar 

  42. Zhang L, Hacke JD, Garrett WE, Liu H, Yu B (2019) Bone bruises associated with anterior cruciate ligament injury as indicators of injury mechanism: a systematic review. Sports Med Auckl NZ 49:453–462

    Google Scholar 

Download references

Funding

No fundings were received for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Etienne Cavaignac.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was approved by the Toulouse Teaching Hospital (“CHU de Toulouse”) ethics committee (DRCI scientific board number 2019-03).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marot, V., Corin, B., Reina, N. et al. Femoral and tibial bone bruise volume is not correlated with ALL injury or rotational instability in patients with ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 29, 900–906 (2021). https://doi.org/10.1007/s00167-020-06045-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06045-x

Keywords

Navigation